- The Caribbean experienced low or moderate
intensity and an increasing trend.

The information in this report was obtained
through the official sites of the Ministries of Health of the countries
in the Region as well as official reports submitted by the International
Health Regulation (2005) National Focal Points. It corresponds to the period
of 18 April to 2 October 2009.

I - Evolution of the pandemic by subregion

North America

The greatest increase in confirmed cases
and deaths was reported in this sub-region during the past week. Mexico
reported a large increase in activity of the pandemic (H1N1) 2009 virus
during the month of September based on the number of confirmed cases.

In the United States, another increase
was observed in the percentage of influenza like illness (ILI) consultations,
which continues to be above the national baseline. A total of 26 states
reported widespread geographic activity of the influenza virus.

In Canada, a large increase in the percentage
of ILI consultations was also observed, above the range expected for this
time of year. Two outbreaks of influenza were reported, one in a school
and one in a long term care facility.

Central America

In Central America, an increase in the
number of confirmed cases was observed, reaching a peak in the month of
July. A gradual and slow decrease has since been observed. No changes in
activity have been recorded since the previous week. The trend in El Salvador
changed from decreasing in the previous week, to increasing. Belize is
the only country that reported a high intensity of respiratory disease.

Caribbean

Some countries in the Caribbean are experiencing
outbreaks in influenza as well as a general increase in activity. Cuba
and Dominica changed their indicator for geographic spread (Cuba increased
from regional to widespread geographic spread and Dominica, which was not
experiencing activity, has reported localized distribution).

South America

In the tropical areas of South America,
a peak in respiratory diseases was observed during the months of May and
June, subsequently in the majority of the region. In general for the majority
of these countries respiratory disease activity began in the capital cities
before spreading to the rest of the country. Paraguay was experiencing
an increase (EW 37) but is now experiencing a decrease in ILI as well as
severe acute respiratory infections (SARI).

In the Southern Cone countries of South
America, the epidemic is steadily decreasing after having peaked during
epidemiological weeks 26 (Argentina, Chile and Uruguay) and 31 (Brazil).